Jules ShermanHealthcare product design & research since 2012

Physical Product · 2020

NOOMA: A delayed cord clamping cart

Clinicians need a way to provide respiratory support to preterm infants immediately after birth while enabling delayed umbilical cord clamping to improve neonatal outcomes.

NOOMA: A delayed cord clamping cart
Stanford Medicine | Stanford, CA | AHRQ-Funded | 2020

Problem

Clinicians need a way to provide respiratory support to preterm infants immediately after birth while enabling delayed umbilical cord clamping to improve neonatal outcomes.

Solution

  1. NOOMA drawing
  2. Top View
  3. Hospital operating room with a delayed cord clamping cart and a medical mannequin on a table, surrounded by surgical tools and supplies.
  4. Jules Sherman in scrubs and a hair cap standing in a hospital room near a delayed cord clamping cart for preterm babies she helped develop at Stanford Medicine.
  5. Simulation day in the OR
  6. Delayed cord clamping cord device for preterm infants with oxygen tanks, and adjustable height stand with wheels.
  7. Hospital neonatal intensive care unit with an incubator and a new delayed cord clamping cart design co-developed with a team at Stanford Medicine.
  8. Medical team performing a cesarean birth on a newborn baby in an operating room using a delayed cord clamping cart prototype.
  9. A sketch-style image of a medical scene with a woman in a hospital bed, team members attending her, and medical equipment in the background.
  10. Two medical professionals with ID badges examining a realistic baby mannequin on a hospital gurney in a hospital room.
  11. A simulation in progress: a team member places an infant mannequin into the clear NOOMA delayed cord clamping cart while a clinician in blue scrubs steadies it, oxygen tanks mounted alongside.
  12. An observational line drawing made in the operating room, held open on a sketchbook: a masked surgical team works over a draped patient during a cesarean birth while the mother lies awake at the right.
  13. The NOOMA cart in a Labor and Delivery room, its clear CPAP surface on an adjustable-height stand with a foot pedal, parked beside an infant warmer.
  14. A simulation on the operating table: the NOOMA cart’s clear surface is positioned over a draped patient’s abdomen, close to the wound site, while a clinician in a surgical cap and gown tends to the infant mannequin resting on it.

NOOMA is a cart and CPAP surface that helps clinicians facilitate delayed cord clamping for any baby, delivering respiratory support at the bedside while the cord blood drains, then enabling safe transfer of the infant to a warming table.

Research & Discovery

“Recommendations for the optimal timing of umbilical cord clamping apply equally to preterm and term births. The guideline development group considered the benefits of delayed cord clamping for preterm infants to be particularly important.”

World Health Organization (WHO)

Delaying cord clamping to at least 60 seconds after delivery is beneficial and recommended for both preterm and term infants. Current protocols allow for delaying cord clamping for the vigorous infant, but initiating safe and effective ventilation for neonates while still attached to the umbilical cord may increase the clinical benefit. Because of the limits of current equipment and space constraints, there is a gap in providing optimal respiratory support to the neonate during the transition period of delayed cord clamping.

We identified several needs for the procedure:

  • A flat surface to perform CPAP resuscitation close to the wound site while the cord blood drains during a C-section (a preterm infant’s umbilical cord is usually 12" or less)
  • Maintaining the sterile field
  • Keeping the baby warm during the procedure
  • Safe transfer of the preterm baby to a larger warming table after delayed cord clamping

Design & Testing

We developed NOOMA as a wheeled cart with a clear CPAP surface that positions the infant close to the wound site during a cesarean birth. The design moved from drawings and CAD models to a working prototype with an adjustable-height stand and mounted oxygen.

We tested the cart through cesarean-birth simulations in the operating room, placing infant mannequins into the cart with the neonatal team to validate CPAP positioning, the sterile field, warmth, and safe transfer to a larger warming table.

Testing

The Team

NOOMA was made possible by the Stanford Medical School Department of Pediatrics and the Center for Advanced Pediatric and Perinatal Education (CAPE), a simulation lab affiliated with Lucile Packard Children’s Hospital and Stanford University. AHRQ Grant #P30HS023506.

PIs: Neonatologists Henry Lee, MD and Louis Halamek, MD

Design Team: Doug Schwandt, MSE, Henry Lee, MD, Chris Rothe, Jules Sherman, MS, MFA

Patent: US 11,344,463 (2022)

The intellectual property for NOOMA has been acquired by Children’s National Hospital and can be licensed through The CNH Innovation Ventures Licensing Office.

The thread

The research behind it

Design Research

Research for NOOMA: A delayed cord-clamping cart

Delayed cord clamping (DCC) is endorsed by multiple professional organizations for both term and preterm infants.